Chapter 14: Chamberlain College of Nursing
NR 341 (A Graded) Latest Questions and
Complete Solutions
Chapter 14: Acute Respiratory Failure
Test Bank
MULTIPLE CHOICE
1. The nurse is caring for a patient with acute respiratory failure and
identifies “Risk for Ineffective Airway Clearance” as a nursing diagnosis. A
nursingintervention relevant to this diagnosis is:
a. Elevate head of bed to 30 degrees.
b. Obtain order for venous
thromboembolism prophylaxis.
c. Provide adequate sedation.
d. Reposition patient every 2 hours.
ANS: D
Repositioning the patient will facilitate mobilization of secretions. Elevating the head
ofbed is an intervention to prevent infection. Venous thromboembolism prophylaxis is
ordered to prevent complications of immobility. Sedation is an intervention to
manage anxiety, and administration of sedatives increases the risk for retained
secretions.
DIF: Cognitive Level: Analysis REF: Nursing Care Plan
OBJ: Formulate a plan of care for the patient with acute respiratory failure.
TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity
2. The patient with acute respiratory distress syndrome (ARDS)
wouldexhibit which of the following symptoms?
a. Decreasing PaO2
levels despite increased
1 / 3
FiO2
administration
b. Elevated alveolar surfactant levels
c. Increased lung compliance with increased
FiO2
administration
d. Respiratory acidosis associated with
hyperventilation
ANS: A
Patients with ARDS often have hypoxemia refractory to treatment. Surfactant levels
areoften diminished in ARDS. Compliance decreases in ARDS. In early ARDS,
hyperventilation may occur along with respiratory alkalosis.
DIF: Cognitive Level: Comprehension REF: p.
410OBJ: Describe the pathophysiology of ARF.
TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
3. The nurse assesses a patient who is admitted for an overdose of
sedatives.The nurse expects to find which acid-base alteration?
a. Hyperventilation and respiratory acidosis
2 / 3
b. Hypoventilation and respiratory acidosis
c. Hypoventilation and respiratory alkalosis
d. Respiratory acidosis and normal oxygen
levels
ANS: B
Hypoventilation is common after overdose and results in impaired elimination of
carbondioxide and respiratory acidosis. The overdose depresses the respiratory drive,
which results in hypoventilation, not hyperventilation. Hypoxemia is expected
secondary to depressed respirations.
DIF: Cognitive Level: Analysis REF: p.
401OBJ: Describe the pathophysiology of ARF.
TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
4. Intrapulmonary shunting refers to:
a. alveoli that are not perfused.
b. blood that is shunted from the left side of
the heart to the right and causes heart
failure.
c. blood that is shunted from the right side
of
the heart to the left without oxygenation.
d. shunting of blood supply to only one
lung.
ANS: C
Shunting refers to blood that is not oxygenated in the lungs.
DIF: Cognitive Level: Comprehension REF: p.
401OBJ: Describe the pathophysiology of ARF.
TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
5. When fluid is present in the alveoli:
Version | 2021 |
Category | ATI |
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Language | English |
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